Here is yet another example of how the conventional model of one organ/one measurement/one drug treatment completely misses the interconnectedness of the body system – what I call the metabolic matrix. Bones are made of more than calcium. The calcium in bones is laid in a matrix, a lattice-work of proteins, lipids, and other minerals. Now comes research suggesting that bone strength is not the same as bone mineral density, though they are related. To put it another way, not everyone with low bone density is susceptible to fractures and vice versa. The integrity of the bony matrix is just as important. This is why we always try to give calcium in a matrix form called micronized crystalline hydroxyl cal apatite or MCHC. And it’s why we look at hormones, inflammation, heavy metals and other toxins, and a wide array of non-calcium nutrients when faced with possible osteopenia or osteoporosis.

Bones can actually be thought of as an endocrine (hormone) organ, constantly in communication with other endocrine organs. Estrogen, testosterone, growth hormone, T3 thyroid, and the brain hormone seratonin are all factors influencing bone health. There’s a lot of overlap between the development of osteoporosis and that of auto-immune disease, chronic infections, cardiovascular illness, diabetes, and even gum disease.

So by all means have bone densities monitored and take a good source of calcium – but also pay attention to the lifestyle interventions that will restore balance among all of your organ systems.

Massage:  Body massage not only feels good, but it can boost immunity, improve sleep, lessen pain, and elevate mood. And remember, it takes energy to keep a muscle in spasm; massage releases that energy to where it’s helpful.

Homeopathy: Used by billions of people around the world, homeopathy relies on the body’s innate ability to heal when given the right energy “message.” It is gentle to the point of being virtually risk-free, and scientific studies demonstrate its effectiveness in a variety of conditions.

Antioxidant nutrients:  All chronic disease – whether it is cancer, heart disease, or auto-immune conditions – involves the oxidation of tissue and its resulting damage. Our tissues protect against this damage by maintaining adequate levels of antioxidant substances like vitamins A, C, and E; the minerals selenium and zinc; and accessory nutrients n-acetyl-cysteine and alpha lipoic acid. Supplementing these nutrients helps combat the ravages of chronic illness.

Movement:  There are almost no conditions in which movement is contra-indicated. Exercise regularly if you are able; if not, then a simple daily walk helps. And if you can’t walk, then seated exercises or even movement in bed has tremendous physiological benefits. Even the simplest movement brings blood and energy to the tissues, oxygenates us, lifts our spirits.

Colorful fruits and vegetables:  Bright colors and tasty flavors result from powerful substances called flavonoids. These substances improve circulation and function of our body tissues. Some, like lycopene from tomatoes, have anti-cancer properties. Others, like hawthorne berry, have been shown to improve heart function. There are hundreds of flavonoids in foods, and these “medicines” are in your salad bowl.

Acupressure:  Acupuncture needles are very slender and rarely painful. However, some people do better with acupressure (also derived from Chinese medicine) which uses finger pressure to move Qi and promote healing. In the hands of a skilled acupressurist or Shiatzu practitioner, this is a safe, non-invasive, and powerful treatment option for problems resulting from chronic illness.

Breathing:  Yes, we all breathe without thinking. But all too often, we fail to breathe deeply and effectively, depriving our bodies of fresh oxygen. Anxiety or pain can limit our chest motion. Trying to breathe slowly, deeply, and fully can increase energy, oxygen, and vitality.

Yoga:  For centuries, yoga has been an integral part of Ayurveda, the native healing system of India. Not all yoga practice involves twisting yourself into knots, like you see in the yoga magazines. Simple yoga postures are doable by nearly everyone, and are in some ways just as effective.

Adaptogenic herbs:  Certain herbs have been studied for their ability to make the body more resilient, and able to handle stress more effectively. These herbs are called adaptogens; commonly-studied ones include eleutherococcus (Siberian ginseng), rhodiola, and astragalus. They’re known for their safety, but should always be taken under the advice of a physician.

Welcome others’ support:  Going it alone is never a good way to cope with chronic disease, and can lead to feeling depressed and isolated. In this age of social networking, there are more ways than ever to feel connected, share stories, and get answers. Having the support of others is a powerful antidote to the worst effects of illness, and is associated with increased life expectancy.

First, make sure to consult the MWRA website regularly, as they offer detailed instructions on boiling and treating water, safe food preparation, etc.

And because many of our patients have weakened digestive tracts and immune systems to begin with, I want to make some suggestions to strengthen the bowel lining, if it should be exposed to abnormal bacteria and parasites. These are basically the same recommendations that I make when people travel to areas with questionable water supplies.

One is a strong probiotic. We use either TruFlora (needs refrigeration) or UltraFlora DF (does not need refrigeration). One capsule twice daily during times of exposure should suffice.

Second, we use the herbal antiparasitic supplement Para-Gard. Two capsules AM and PM after meals is the proper dose.

Third, we use a pre-biotic, L-Glutamine, to strengthen the bowel wall. I recommend L-Glutamine FOS powder, 1/2 teaspoon twice a day, in water that has been at a rolling boil for two minutes, of course.

This particular researcher gave pregnant Agouti mice a diet high in folic acid and Vitamin B12 — two nutrients critical to healthy genetic activity. The children these mice gave birth to were thinner than their parents, and had lower incidents of cancer and diabetes. Perhaps most astonishingly, they lived longer!

The essence of integrative medicine lies in the belief that one’s health improves by improving certain influential factors – nutrition, energy systems. toxicity, activity level. But this study seems to paint an even more compelling picture – that improving our own health might have positive effects on our children genetically. This is truly astounding.

I was taught in medical school that genes were like old books of conduct – static and immutable. It looks as if the actual truth is closer to the old Iroquois law, that our actions (in this case, those affecting our health) will affect the seventh generation after us.

Wow.

Generally, cupping is most often used to relieve congestion, inflammation, or poor circulation. The practitioner creates suction either with a plunger, or with flame held briefly to the cup rim, and applies cups to the affected area (watch a session here).  In the case of poor circulation, the suction draws areas of microclotting to the skin surface and promotes better circulation throughout the deeper tissues. I have successfully cupped patients with asthma, muscle aches and spasm, arthritis, even digestive problems. 

So how does it feel? One patient with fibromyalgia whom I see regularly describes it as “a deep-tissue massage, like someone is accessing that soreness between my shoulders and massaging it away. It’s deeply relaxing, and I can feel my body detoxing.”

Anyone with circulation issues should check with their physician before pursuing cupping therapy, and pregnant women should avoid it completely. But the rest of us could learn a thing or two from our grandparents.

A recent example – the FDA convened a joint advisory committee a few weeks ago to investigate acute liver failure and overdoses related to Acetaminophen (the primary ingredient in Tylenol, as well as in prescription Vicodin and Percaset). More than 400 people die and about 42,000 are hospitalized each year because of Acetaminophen overdoses. Why? Some people ignore the label instructions, but it’s thought that many more do not realize they are combining Acetominophen-based drugs: they take Tylenol with Vicodin, for example, and rapidly exceed the maximum daily intake.

But no matter the dose, Acetaminophen is hard on the liver, and people in chronic pain would do well to consider some alternatives. Fortunately there are many natural products that can be used for pain and inflammation safely and effectively, with research to prove it. Here are some of my favorites:

Proteolytic enzymes: these enzymes are taken between meals and are anti-inflammatory and therefore pain-relieving. They can also enhance the effectiveness of antibiotics and other pain relievers.

Omega III fatty acids: the EPA fatty acids in Omega III, which come from fish oil, make the anti-inflammatory hormones in our body. Multiple studies have indicated fish oil’s distinct anti-inflammatory effect on rheumatoid arthritis and other inflammatory conditions.

DL-Phenylalanine (DLPA): This form of a common immunoacid works by itself to lessen pain; it also enables narcotics to be used at a lower dose.

Curcumin: The active ingredient in turmeric, curcumin has a proven affect on inflammation and pain relief. It has also been used effectively in treating some forms of cancer.

Kaprex: this potent form of botanical medicine is largely an extract of hops. The extract (known as THIAA) has a direct effect on the prostaglandin E2, which is responsible for much of the inflammation in joints and other pain areas. Kaprex has been found to be at least as effective as pain relievers in cases of arthritis and other joint inflammations.

First, if statins work to lower cholesterol, why go to an herbal supplement at all? Unfortunately, statins have a huge impact on the liver, and carry heavy side-effects. They block an enzyme (HMG-Co A reductase) that has more than one function in your body; so blocking it lowers cholesterol, but also often results in muscle ache and fatigue.

Red yeast rice actually contains a natural statin (Monacolin K – what Lovastatin, or Mevacor is made from). Other components of red rice yeast also have positive effects on cholesterol metabolism; furthermore, each of these components exists in a much lower amount than they would in a statin drug. The end result is a milder but still significant lowering of cholesterol, and a much lower instance of aches and fatigue.

When considering natural supplements in place of pharmaceutical medications, I operate by the 80/20 philosophy. About 80% of patients using medications can probably get the same or an acceptable result by using supplements. And, in general, the supplements will give about 20% of the side-effects of prescription meds. Now obviously there are patients who need to take statins; I am certainly not recommending that everyone get off statins.  But the majority of patients with high cholesterol can improve with an appropriate dose of red yeast rice. For those with high blood sugar and fat density around the waist, I also add niacin and fish oil.

Here’s another caveat, and I’m glad this has been stressed in every article I’ve read: not all red yeast rice supplements are what they say they are. The FDA is still choosing not to regulate nutritional supplements, and too many products on store shelves are contaminated. As with any herbal supplement, buy from a reputable source – preferably a medical professional.

The symptoms: First, it’s important to remember that what’s often referred to as the “bulls-eye” Lyme Disease rash (called Erythema Migrans rash or EMR) is present in less than half of Lyme cases. And yet, many patients and most doctors don’t even consider Lyme unless there’s a clear history of tick bite and rash. Add to that picture the thousands of patients who had the rash but never saw it, or who saw the rash but didn’t recognize it as EMR, and it’s even clearer why so many people don’t get better. Here’s the bottom line when it comes to symptoms: first, almost all of us live in an area populated by deer ticks (this pertains to most of the US and surprisingly large areas of the world), so almost all of us are at risk. If you suffer from

• unusual and unexplained fatigue
• unusual and unexplained aches and pains
• neurological symptoms including headaches, visual problems, ear ringing, numbness/tingling, and “electric” sensations throughout the body

then you should ask your physician to consider testing for Lyme Disease. Unfortunately that’s when things often get more complicated.

The Diagnosis: I can’t tell you how many patients have said to me “My doctor tested me and I was negative.” Testing for the Lyme bug (called a spirochete) is very difficult, because of the nature of the spirochete and how well it hides. But many doctors rely on insufficient testing. Most use the ELISA, which is not nearly sensitive enough, and often produces a false negative; and many don’t work hard enough to make sense of that elusive Lyme spirochete.

First, the spirochete: it lives in a cell, and has a life cycle of 3-6 weeks. Every month or so, it peeks out of the cell, and the immune system forms a reaction to it. Keep that in mind as we talk about testing.

The only reliable way to test for Lyme is by properly testing the blood for evidence of an immune reaction: if there’s a reaction, we know that Lyme has been there. It’s like when the detective in an old crime novel  finds a cigarette butt in the ashtray: he knows the bad guy has been around. And if the cigarette butt is still warm, he’d better check the closets and under the bed. The Lyme tests that I use are 2 Western Blot tests called an IgG (immunoglobin G) and an IgM (immunoglobin M). The IgG shows whether there’s been an immune reaction to Lyme (cigarette butt in the ashtray); the IgM can pinpoint that exposure to 6-8 weeks (the still-glowing cigarette butt).

In testing, any immuno-reaction is given a number called a band. Some bands are very specific to Lyme, while others can be positive from reactions to a number of organisms. If enough Lyme-sensitive bands are positive, they highly suggest a Lyme scenario, just like jigsaw pieces gather to suggest an image.

So why so many false negatives? For one thing, many physicians stop hunting after a negative ELISA. Also, the labs who commonly test for Lyme do not use a particularly sensitive Western Blot test, and – here’s what really baffles me -many Western Blot assays do not include the 31 and 34 bands, even though these are most sensitive to Lyme. Without those bands, the assays are read as negative.

And another big problem: many physicians ignore a positive IgM result. This makes no sense, as a positive IgM is considered ample evidence in most other infectious disease diagnosis. Yet I can’t tell you how many positive IgMs are ignored, even if the right bands are tested. In many cases, the lab tests are done in the winter months, when a physician can’t explain why a recent immune test would be positive without live ticks around. But there’s an easy explanation for a positive IgM test in the winter, and it relates to what I said earlier about life cycles. Every time that spirochete peeks out of the cell, it’s like a re-infection. For that reason, I consider a wintertime IgM to be a diagnostic indicator of Lyme in someone’s system.

TOMORROW – how I treat Lyme Disease

I’ve never disliked anything Michael J. Fox has been in, from Family Ties to his recent run on Rescue Me. (All right, Spin City could be a bit lame.)   And of course, we share an illness.  But I developed a new respect for him after attending a roundtable discussion last night on Parkinson’s Disease Research hosted by his foundation (http://www.michaeljfox.org/ , known as the MJFF).

I’m assuming an organization gets its mission and personality from the top. And certainly Michael J. Fox is a celebrity with powerful connections and reach. But lots of well-intentioned famous people have started foundations that haven’t exactly exploded onto the landscape (ever heard of the Bruce Willis Foundation?)  The MJFF, devoted to finding and funding viable PD research, is hugely impressive.  They’re laser-focused on their mission, very well organized and attracting bright talent; last night’s discussion included a few of the country’s top PD researchers, including Harvard Medical School’s Michael Schwarzchild. They’re innovative, and willing to work with both academia and the corporate world in novel ways.

They have heart. Sure, someone cued up the promotional video for Team Fox, and the whole room welled up. But the foundation’s appeal goes beyond slick production values; they seem genuinely interested in people’s stories, and in not letting them get lost in the larger statistics of research.   And their work is inspirational, no doubt offering hope to a lot of people.  This inspiration clearly comes from Michael himself.

I’ve got caller ID at home to keep fundraisers away, along with telemarketers and various nuisances.  But if I looked down today and saw MJFF, I think I would answer.

When you can buy supplements on every streetcorner, how do you know what you’re buying is safe and effective? 

• Do Your Homework. There’s an excellent group called ConsumerLab that works just like Consumer Reports; they buy just like you and I do, off the shelf, and test/rate supplements for quality and safety (our practice’s Natural Apothecary is a voluntary member of ConsumerLab). There’s a yearly fee to subscribe; check out their website for more information and testing results.
• Buy pharmaceutical-grade. I know it’s easy to throw a few products in your cart at the supermarket, but you may be throwing your money away. The only way to guarantee quality and safety is to buy supplements from a reputable supplier whom you trust.

Here’s more information on the supplement industry, in a recent article posted by the Associated Press: http://tinyurl.com/llz6xx